If Slavitt Heads CMS, Rulemaking Will Be Key

Prepare for a cascade of new regs

WASHINGTON -- If he is confirmed by the Senate as the administrator of the Centers for Medicare and Medicaid Services (CMS), Andy Slavitt will face many challenges in just keeping the Medicare and Medicaid programs humming, experts said.

"It's a huge amount of work," Dan Mendelson, MPP, CEO of the Washington-based healthcare consulting firm Avalere, told MedPage Today in a phone interview. "There are hundreds of rules coming out over the next 18 months, and all of them will require thoughtful consideration and working with Congress -- never mind the Centers for Medicare and Medicaid Innovation and all the interesting stuff they're doing, like orthopedic bundling."

Slavitt has been acting administrator of CMS since March, following the resignation of Marilyn Tavenner. Last Thursday, President Obama nominated him to become permanent administrator. Prior to arriving at CMS, Slavitt served as group executive vice president at Optum, the consulting arm of of UnitedHealth Group, and was CEO of OptumInsight, Optum's health information technology division, from 2006 through 2011.

Slavitt also was founder and CEO of HealthAllies, a company that helped find healthcare for uninsured or underinsured patients. In addition, he previously worked as a consultant with McKinsey & Company, and as an investment banker with Goldman Sachs.

Gail Wilensky, PhD, an economist and senior fellow at Project Hope in Bethesda, Md., told MedPage Today that while she couldn't predict whether or not Slavitt would be confirmed by the Senate, she didn't see any red flags that would prevent his confirmation.

"I don't hear strong opposition, but I do hear some issues raised, which are the ones you'd expect given his background [in the health insurance industry]," said Wilensky, who served as administrator of what is now CMS under President George H.W. Bush. "But having anything to do with industry isn't necessarily a non-starter; [former administrator Tom] Scully was CEO of the Federation of American Hospitals and that didn't seem to have a negative effect on his confirmation."

Wilensky noted that it was a little unusual for someone to be nominated for a position like this so late in the president's term. However, she and several other experts agreed that it is advantageous to have a permanent -- rather than an acting -- administrator in the position. "It enables better communication back and forth with Congress, and that's important for getting stuff done," Mendelson said.

"In a formal, practical sense there's not all much difference, but makes a great deal of difference in terms of ability of the person in that job to function independently relative to the rest of the executive branch more than anything else," said Bruce Vladeck, PhD, a senior advisor at the New York City health consulting firm Nexera and former administrator of what is now CMS under President Bill Clinton.

"An acting person could be gone tomorrow; you can always fire a confirmed person but then you have to replace them. It just has more gravitas. Given all the pressure pulling in every direction on CMS, that's very helpful."

As for what Slavitt's duties will be, "there's an awful lot of stuff in the pipeline," Vladeck said in a phone interview. Slavitt "has been particularly involved in fixing healthcare.gov and there's still more work to be done in continuing to get that working better and get the outreach working better ... [including] getting the [enrollment] numbers up in some of those hard-to-reach populations."

In addition to that, "the [SGR repeal] legislation has a ton of stuff in there about changes in physician quality measurement, physician payment, promotion of primary care, and there's going to be a desire to try to get as much in place by the end of the administration as possible," he continued. "Then you still have two 'mega-regulations' in the pipeline on the Medicaid side: the so-called access regulations ... and a very important regulation on Medicaid managed care, and a strong desire to get both of those finished by the end of the administration."

Finally, "you have number of states where politics of the Medicaid expansion is going to heat up again next year, which means a lot of potential negotiations with CMS about the specifics of state plans. That will keep him busy."

A lot of the job, said Wilensky, "is just to remember that the major focus of CMS is and should remain being the administrator for Medicare and Medicaid, and those programs have only gotten bigger ... in the last few years. The main kinds of changes are going to [involve] continuing the oversight functioning of these major programs; that's generally more than enough to keep us administrators busy in a relentless fashion."

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.